What do social determinants of health affect in the context of CMS reimbursement?

Social determinants of health refer to the conditions in which people are born, grow, live, work, and age, and they encompass a range of factors including socioeconomic status, education, neighborhood and physical environment, employment, social support networks, as well as access to healthcare. In the context of CMS reimbursement, these determinants significantly influence healthcare access and outcomes, which is crucial for understanding how care is delivered and the associated costs.

This impact manifests in various ways, such as affecting a patient’s ability to access healthcare services, adhere to treatment plans, and ultimately achieve better health outcomes. Patients living in disadvantaged socio-economic conditions may face barriers like lack of transportation, inadequate health literacy, or food insecurity, which can lead to poorer health and higher healthcare costs. CMS recognizes that addressing these social determinants can improve patient care and lower overall expenditures by enhancing health outcomes.

By integrating considerations of social determinants, CMS aims to promote health equity and improve population health, making this option the most relevant in the context of reimbursement policies. Understanding this relationship between social determinants of health and healthcare utilization is critical for developing appropriate reimbursement models that support comprehensive patient care.